Welcome to Season 2, Episode 1 of The Clinical Chronicle.

This episode delivers major practice-changing updates in medicine for 2026, including the new AHA and ASA acute ischemic stroke guideline, evolving evidence on sodium correction in severe hyponatremia, and why current lung cancer screening criteria may be missing more than 60 percent of patients at diagnosis.

We break down expanded eligibility for endovascular thrombectomy in larger core strokes, the shift toward dual antiplatelet therapy over thrombolysis for minor nondisabling stroke, and updated blood pressure management recommendations in acute ischemic stroke. These changes are highly relevant for hospitalists, emergency physicians, neurologists, and internal medicine residents preparing for ABIM and ITE exams.

We also examine new data challenging long-standing slow correction thresholds in severe hyponatremia. Observational findings suggest that medium or faster sodium correction may be associated with lower mortality and fewer neurologic complications compared with very slow correction, prompting reexamination of current guideline targets.

In oncology and cardiometabolic medicine, we review:

• Lung cancer screening data showing 64.9 percent of patients did not meet USPSTF criteria at diagnosis • An age-based low-dose CT screening model that could prevent more than 25,000 deaths annually • GLP-1 receptor agonists associated with a 54 percent reduction in mortality among colon cancer patients with obesity • Survivorship data revealing substantial risk of non-lung secondary malignancies after curative treatment for non-small cell lung cancer

We also discuss projected U.S. obesity prevalence reaching nearly 47 percent by 2035, with major implications for diabetes, cardiovascular disease, chronic kidney disease, and health system demand.

In gastroenterology, real-world multicenter data demonstrate durable clinical, endoscopic, and histologic remission with upadacitinib in ulcerative colitis at one year.

In neurology and environmental health, long-term air pollution exposure is linked to increased risk of motor neuron disease, including ALS, as well as faster functional decline and higher mortality.

Additional updates include heavy lifetime alcohol use and colorectal cancer risk from PLCO trial data, and sex-specific response to varenicline in cannabis use disorder, where benefit was observed in men but not women.

We also introduce a new recurring segment, Before You Order That Test, inspired by Choosing Wisely principles and focused on high-value care. This episode highlights a critical reminder: do not diagnose or manage asthma without spirometry.

This podcast is designed for internal medicine residents, fellows, hospitalists, and attending physicians who want concise, clinically relevant updates across stroke, oncology, cardiometabolic disease, gastroenterology, preventive medicine, and public health.

Be relentless. Save lives.

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